Activity 6: Managing Coexisting Pain and Depression

Program Overview

Pain and depression often coexist and the combination is associated with worse clinical outcomes than either condition alone. If not recognized and managed, each can negatively affect the clinical outcome of the other. Better recognition, assessment, and treatment of co-morbid pain can enhance outcomes of depression therapy. Better recognition, assessment, and treatment of co-morbid depression can enhance outcomes of pain therapy. Thus, a primary care treatment model that incorporates assessment and treatment of both depression and pain is optimal.

In Managing Coexisting Pain and Depression, a video case dramatization is used to demonstrate the process of care when chronic pain and depression are present. Faculty will use the case to discuss clinical decision-making, the therapeutic partnership, diagnostic and monitoring tools, and strategies to effectively manage depression in patients with chronic pain.

Intended Audience

This continuing medical education program is intended for family practitioners and other healthcare professionals who manage depression and pain management.

Learning Objectives

After completing this activity, participants will be better able to:

  • Recognize the high prevalence of depression in patients with chronic pain and the impact it has on pain outcomes
  • Utilize structured assessments to diagnose and monitor depression and track progress of pain-relieving therapy in patients with chronic pain syndromes
  • Manage depression and pain when they co-exist, including medical and behavioral options
  • Use communication and management strategies to improve outcomes and overcome barriers in the care of chronic pain patients with depression


Michael S. Klinkman, MD, MS
Associate Professor, Departments of Family Medicine and Psychiatry
University of Michigan Depression Center
Ann Arbor, MI

Judith A. Turner, PhD
Professor, Department of Psychiatry and Behavioral Sciences
University of Washington
Seattle, WA

Planning Committee

Neil Skolnik, MD
Professor of Family and Community Medicine
Temple University School of Medicine
Family Medicine Residency Program
Abington Memorial Hospital
Abington, PA

Jeffrey T. Kirchner, D.O., FAAFP
Associate Director – Family Medicine Residency Program
Lancaster General Hospital / Temple University School of Medicine
Lancaster, PA

Dawn A. Marcus, MD
Associate Professor
University of Pittsburgh Medical Center
Pittsburgh, PA

Penny Tenzer, MD
Vice Chair, Director of the Residency Program
University of Miami, Miller School of Medicine
Chief of Service for Family Medicine
University of Miami Hospital
Miami, FL

CME Accreditation

This activity, Managing Coexisting Pain and Depression, has been reviewed and is acceptable for up to 1 Prescribed credit(s) by the American Academy of Family Physicians. This activity conforms to the AAFP criteria for evidence-based CME clinical content. AAFP accreditation begins June 21, 2009. Term of approval is for two years from this date with the option of yearly renewal. This activity has been renewed from June 21, 2011 through June 21, 2013.

The EB CME credit awarded for this activity was based on practice recommendations that were the most current with the strongest level of evidence available at the time this activity was approved. Since some clinical research is ongoing, the American Academy of Family Physicians recommends that learners verify sources and review these and other recommendations prior to implementation into practice.

The AAFP is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Family Physicians designates this education activity for a maximum of 1 AMA PRA Category 1 credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Introduction and Opening Remarks
Module 1: The Relationship between Chronic Pain and Depression
                   Video Vignette - Physician’s First Visit with Patient
Module 2: Diagnosing Depression in the Patient with Chronic Pain: Establishing a Therapeutic Partnership
                  and Initiating Treatment
                   Video Vignette - Progression of First Visit and Follow-up Visit at 3 Weeks
Module 3: Ongoing Management of the Patient with Co-Existing Pain and Depression
                   Video Vignette - Summary of Key Elements of Care in Past 2-3 Visits
Closing Remarks


It is the policy of the AAFP that all CME planning committee/faculty/authors/editors/staff disclose relationships with commercial entities upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interests and, if identified, they are resolved prior to confirmation of participation. Only these participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity.

The AAFP and MedEd Architects staffs have indicated that they have no relationships to disclose relating to the subject matter of the activity. Drs. Turner, Skolnik, Kirchner, Marcus, Tenzer, and Pomm have returned a disclosure form indicating that she/he have no financial interest in or affiliation with any commercial supporter or providers of any commercial services discussed in this educational material.

Dr. Klinkman has returned a disclosure form indicating that he is a member of the Depression and Anxiety Clinical Consultant Board for Wyeth Pharmaceuticals, is an unpaid member of the Medical Advisory Board for Cielo MedSolutions, LLC, and receives royalty payments from Cielo MedSolutions, LLC for technology licensed by the company.

Please note that faculty is required to disclose all relevant relationships prior to the beginning of the activity.


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